Provider Demographics
NPI:1710448956
Name:KOH, HILLARY (DDS)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:KOH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15446 N GREENWAY HAYDEN LOOP UNIT 3073
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3148
Mailing Address - Country:US
Mailing Address - Phone:650-867-2261
Mailing Address - Fax:
Practice Address - Street 1:3264 N GLASSFORD HILL RD STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1353
Practice Address - Country:US
Practice Address - Phone:928-759-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0104451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice